Form-Vessel Classification of Cholangioscopy Findings to Diagnose Biliary Tract Carcinoma's Superficial Spread.

Yoshimitsu Fukasawa,Ei Takahashi,Hiroko Shindo,Mitsuharu Fukasawa,Shinya Maekawa,Yasuhiro Nakayama,Nobuyuki Enomoto,Shinichi Takano,Sumio Hirose,Satoshi Kawakami,Tatsuya Yamaguchi,Makoto Kadokura,Tadashi Sato,Hiroshi Hayakawa,Taisuke Inoue

doi:10.3390/ijms21093311

Yoshimitsu Fukasawa, Ei Takahashi + Show 13 more

Open Access

https://doi.org/10.3390/ijms21093311

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Abstract

We aimed to evaluate a newly developed peroral cholangioscopy (POCS) classification system by comparing classified lesions with histological and genetic findings. We analyzed 30 biopsied specimens from 11 patients with biliary tract cancer (BTC) who underwent POCS. An original classification of POCS findings was made based on the biliary surface’s form (F factor, 4 grades) and vessel structure (V-factor, 3 grades). Findings were then compared with those of corresponding biopsy specimens analyzed histologically and by next-generation sequencing to identify somatic mutations. In addition, the histology of postoperative surgical stumps and preoperative POCS findings were compared. Histological malignancy rate in biopsied specimens increased with increasing F- and V-factor scores (F1, 0%; F1, 25%; F3, 50%; F4, 62.5%; p = 0.0015; V1, 0%; V2, 20%; V3, 70%; p < 0.001). Furthermore, we observed a statistically significant increase of the mutant allele frequency of mutated genes with increasing F- and V-factor scores (F factor, p = 0.0050; V-factor, p < 0.001). All surgical stumps were accurately diagnosed using POCS findings. The F–V classification of POCS findings is both histologically and genetically valid and will contribute to the methods of diagnosing the superficial spread of BTC tumors.

Highlights

Biliary tract cancer (BTC), which arises from the biliary epithelium of the intrahepatic, extrahepatic, and gallbladder bile ducts, accounts for about 3% of all gastrointestinal cancers [1] and is the sixth leading cause of cancer death [2]
We developed a classification system based on peroral cholangioscopy (POCS) findings in surface and vessel structures to diagnose BTC tumor spread
The system was validated by comparing it to the histological diagnosis and genetic mutation analysis in simultaneously biopsied specimens

Summary

Introduction

Biliary tract cancer (BTC), which arises from the biliary epithelium of the intrahepatic, extrahepatic, and gallbladder bile ducts, accounts for about 3% of all gastrointestinal cancers [1] and is the sixth leading cause of cancer death [2]. Earlier studies have reported the primary tumor’s superficial spread or extension in 31.6–39.3% of BTC cases, with more than 20-mm length of superficial spread in 14.6–17.9% cases [6,7]. These lesions can be identified using ultrasonography [8], multi detector-row computed tomography (MDCT) [9], and magnetic resonance imaging [10]. Intraductal ultrasonography (IDUS) during endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be beneficial for both qualitative diagnosis and the diagnosis of the main tumor’s superficial spread [11,12] These methods have a limited diagnostic accuracy in terms of the superficial tumor spread. To date, there are no reports systematically classifying POCS findings

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